5613341 REAL-WORLD CHANGES IN KIDNEY FUNCTION FOR PATIENTS WITH SICKLE CELL DISEASE OR OTHER ANAEMIAS RECEIVING IRON CHELATION THERAPY IN THE US
Authors: S.B. Sunil Bhandari, E.I. Emmeline Igboekwe, N.T.T. Noemi Toiber Temin, K.A. Khashayar Azimpour, J.A. Jonathan Alsop, C.F. Caroline Fradette, F.T. Fernando Tricta
Journal: HemaSphere (2023)

Background: Treating sickle cell disease (SCD) and other anaemias with frequent blood transfusions increases the bodily iron burden, which can be mitigated through iron chelation therapy (ICT).1 As these populations age, impaired kidney function becomes more prevalent, which is also impacted by disease progression and use of ICT.1 An understanding of how kidney function changes over time for real-world patients on ICT is critical for optimal long-term management. Aims: To evaluate real-world changes in kidney function, specifically in estimated glomerular filtration rate (eGFR) and serum creatinine levels in patients with SCD or other anaemias and who received ICT in the United States (US). Methods: Electronic medical records were gathered from the TriNetX electronic database, representing 46 US healthcare organisations. Records were dated between 1999 and 2021 (data cutoff date: September 7, 2021). The baseline period for each patient was defined as the 365 days prior to the date ICT was first dispensed; the follow-up period was the following 730 days (24 months). eGFR and serum creatinine assessments during the follow-up period were analysed using a mixed model repeated measures approach, adjusted for first iron chelation event, age, sex, race, time of assessment, and baseline eGFR, creatinine, and haemoglobin. Eligible patients had to have at least 2 eGFR measurements during follow-up. Study endpoints were changes in eGFR, serum creatinine level, proteinuria, and albuminuria over time, as well as the proportion of patients with SCD or other anaemias who developed kidney impairment (eGFR <60 mL/min/1.73m2) during follow-up. Results: Analyses of eGFR and creatinine levels were conducted on a total of 1527 patients diagnosed with SCD (n = 1510) or other anaemias (n = 17). More patients were first dispensed deferasirox (n =1237) than deferoxamine (n = 223) and deferiprone (n = 67). Compared to baseline, eGFR values remained stable over 24 months after patients were dispensed deferiprone, while there were statistically significant decreases in eGFR over the same period for those given deferasirox or deferoxamine (Table 1). The proportions of patients with SCD or other anaemias who developed kidney impairment during follow-up were 13.9% (deferasirox), 9.2% (deferoxamine), and 11.9% (deferiprone). There were statistically significant reductions in eGFR and statistically significant increases in serum creatinine over 24 months from baseline among patients who first received deferasirox and deferoxamine (Table 1). Proteinuria and albuminuria analyses were not completed due to insufficient data; similarly, a small number of patients in the database were diagnosed with other anaemias to support distinct, formal analysis for this patient group. Summary/Conclusion: The data from this real-world US analysis indicate patients who were prescribed deferiprone had worse baseline kidney function prior to initiation of ICT. The data also indicate that deferiprone has a lesser detrimental impact on kidney function as measured by eGFR and serum creatinine level. This study could not assess treatment adherence. Although there are limitations owing to the retrospective nature of the data, the results may assist clinicians should in their choice of ICT for patients who have or are at risk for developing kidney impairment.Reference 1. Bhandari, Galanello, Eur J Haematol 2012; 89:187